Your spot will be reserved when both your application and liability form are submitted and we have received a 50% deposit of $70 (cash or check), due February 15th, 2018.

Final payment of $70 due March 4th.

Please make checks payable to “St. Pius X” and on the memo write down “Retreat-Teen Name”

A “What to Bring List” will be made available on this page February 15th, 2018.

Please provide your own transportation to and from the retreat center. The center is about an 1hr away from St. Pius X. Rides are provided on a limited basis. If you are a parent who would like to carpool, please let us know in the parent section below.

All questions and concerns can be directed to Paola Peña at ppena@st-pius.org

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Life Teen 2018 Retreat

Register for the Retreat

Step 1 of 2 - Student Section

50%

Student Name*

FirstLast

Student Email*

Student Cell Phone*

Which youth group do you attend?*

Grade*

Gender*

Dietary Restrictions

How can we pray for you as you prepare for the retreat?

Parent Contact Name*

FirstLast

Parent Contact Email*

Parent Cell Phone*

Home Phone*

Can you provide/find transportation for your teen?

I would like to assist in the following area(s):

Carpooling

Intercessory Prayer

Other

*I can carpool

I am VIRTUS trained and will email you a copy of my certificate

I am not VIRTUS trained

Please email me the "Volunteer Driver Form"

*Provided that I am VIRTUS trained and fill out the "volunteer driver form". If you are not VIRTUS trained, you need to only to take a 3hr Safe Environment Class provided by the Diocese. Follow this link https://www.virtusonline.org/virtus/ and sign-up as a "First-Time Registrant" to register for a class at your convenience.

Complete Medical/Communication Form

From can be found right above this form. Print, fill out, and return to Paola.

Media Waiver*

I hereby grant permission for my youth to be photographed and/or interviewed for print, radio, television or electronic media should it arise. I understand photographs or quotations may be reprinted on other media, including but not limited to television, radio, newspapers, and the internet, for public dissemination. I release and relieve St. Pius X Catholic Church and the Diocese of Bridgeport from any responsibility or liability for any claims arising from publication or reproduction of any photographs or interviewers in any news or other media. I waive any and all rights to inspect or approve the finished photographs or printed matter that may be used in conjunction with any photograph, or to approve the eventual use for which it may be applied. I also understand that the photography or interview is being done with the knowledge and approval of St. Pius X Catholic Church and the Diocese of Bridgeport, but that a signed release form is on file for every individual who is photographed or interviewed by the media.